Provider Demographics
NPI:1184193781
Name:BABCOCK, AMY E (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1538 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55055-1070
Mailing Address - Country:US
Mailing Address - Phone:321-890-7535
Mailing Address - Fax:
Practice Address - Street 1:310 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3218
Practice Address - Country:US
Practice Address - Phone:612-223-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN2594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1184193781OtherNPI I